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CPIN Student Application Form

Prospective Collaborative Program In Neuroscience (CPIN) students may fill in and submit the below application form. All applications must include the completed CPIN Student Application Signature Page that can be found at this link

To ensure that the form has been received by us, please wait for a confirmation message upon submission. We recommend Google Chrome or Mozilla Firefox to fill the form.

Before being admitted into CPIN, a student must be registered in a home graduate unit. To view a list of participating units, click here.

Students must meet all program requirements as listed on the website in order to graduate with the CPIN Notation on their transcript, no exceptionsClick here for details.

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Student Information
First Name:
Last Name:
Student Number:
Department:
Degree Program:
SGS Registration Date:
Pick date
Student E-mail Address:
 
Title/Topic of Research:
Expected length of study (years):
Supervisor's Name:
Supervisor's E-mail Address:
 
LAB ADDRESS
Address:
Institution:
City:
Province:
Postal Code:
Phone Number:
 
HOME ADDRESS
Address:
City:
Province:
Postal Code:
Phone Number:
 
Signature Page
Please attach your completed CPIN Student Application Signature Page here (see above for download link):
If you do NOT wish to be listed on the CPIN website, please check box: